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Effects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial
Junichi Ishigami1, Jeanne Charleston1, Edgar R Miller1,2
1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Insights
Using the wrong blood pressure (BP) cuff size leads to inaccurate readings. A regular BP cuff significantly underestimates BP in small arms and overestimates it in large arms, highlighting the need for individualized cuff selection.
Area of Science:
- Cardiovascular medicine
- Medical devices
- Clinical diagnostics
Background:
- Clinical guidelines recommend using BP cuffs matched to mid-arm circumference.
- The impact of incorrect BP cuff sizing on automated BP measurements is not well-quantified.
Purpose of the Study:
- To assess the effect of using a regular BP cuff versus an appropriately sized cuff on automated BP readings.
Main Methods:
- A randomized crossover trial involving 195 community-dwelling adults.
- Participants underwent BP measurements using appropriately sized, too-small, and too-large cuffs in random order.
- BP readings were stratified by cuff size and participant characteristics.
Main Results:
- A regular cuff significantly lowered systolic BP by -3.6 mm Hg in individuals needing a small cuff.
- A regular cuff significantly increased systolic BP by 4.8 mm Hg and 19.5 mm Hg in those needing large and extra-large cuffs, respectively.
- Inaccurate BP measurements were more pronounced with larger deviations from the appropriate cuff size.
Conclusions:
- Miscuffing leads to significantly inaccurate automated BP measurements.
- Routine use of a single regular BP cuff size can result in critical measurement errors.
- Individualized BP cuff selection based on arm circumference is essential for accurate BP monitoring.
Importance:
Clinical practice guidelines recommend selecting an appropriately sized cuff based on mid-arm circumference prior to measuring blood pressure (BP). To our knowledge, the effect of miscuffing on BP measurement when using an automated BP device has not been quantified.
Objective:
To determine the effect of using a regular BP cuff vs an appropriately sized BP cuff on automated BP readings.
Design, Setting, And Participants:
This randomized crossover trial of community-dwelling adults with a wide range of mid-arm circumferences took place between March 16 and October 25, 2021, in Baltimore, Maryland. Participants were recruited via BP screening events at a public food market and a senior housing facility, targeted mailings to prior research participants, placement of study brochures in hypertension clinics at Johns Hopkins University, and referrals from physicians providing hypertension care to adults.
Interventions:
Participants underwent 4 sets of triplicate BP measurements, with the initial 3 sets using an appropriate, too-small, or too-large BP cuff in random order; the fourth set of triplicate measurements was always completed with an appropriate BP cuff.
Main Outcomes And Measures:
The primary outcome was the difference in mean BP when measured with a regular BP cuff compared with an appropriate BP cuff. The secondary outcome was the difference in BP when using too-small or too-large BP cuffs vs an appropriate BP cuff across all cuff sizes. Results were also stratified by systolic BP (≥130 mm Hg vs <130 mm Hg) and body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30 vs <30).
Results:
A total of 195 adults (mean [SD] age, 54 [16] years; 67 [34%] male; 132 [68%] Black; 100 [51%] with hypertension) were randomized for inclusion. Among individuals requiring a small BP cuff, use of a regular BP cuff resulted in a statistically significant lower BP reading (mean systolic BP difference, -3.6 [95% CI, -5.6 to -1.7] mm Hg). In contrast, among individuals requiring a large or extra-large BP cuff, use of a regular BP cuff resulted in a statistically significant higher BP reading (mean systolic BP difference, 4.8 [95% CI, 3.0-6.6] mm Hg and 19.5 [95% CI, 16.1-22.9] mm Hg, respectively). For the secondary outcome, BP differences with overcuffing and undercuffing by 1 and 2 cuff sizes were greater among those requiring larger BP cuffs. The results were consistent in stratified analyses by systolic BP and body mass index.
Conclusions And Relevance:
In this randomized crossover trial, miscuffing resulted in strikingly inaccurate BP measurements. This is particularly concerning for settings where 1 regular BP cuff size is routinely used in all individuals, regardless of arm size. A renewed emphasis on individualized BP cuff selection is warranted.
Trial Registration:
ClinicalTrials.gov Identifier: NCT04610775.
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Prepare for the Procedure: